Context, Understanding and Co-Production: Reflections from the Lambeth PBS Evaluation
“The most basic of all human needs is the need to understand and be understood.”
– Ralph Nichols
This principle sits at the heart of meaningful support. For people to be truly understood within services, they must be recognised not as passive recipients of support, but as active participants in shaping it.
These themes of understanding, participation and context were central to a recent evaluation of Positive Behaviour Support (PBS) in the London Borough of Lambeth. Commissioned by Lambeth Council and carried out in partnership with Black Thrive and Novarta & Partners, the evaluation explored how PBS is experienced by Black individuals and families in the borough. Positive Support Group (PSG) contributed as the provider of PBS within the programme.
The work was undertaken against a wider backdrop of inequality in health and social care. National evidence continues to show that Black and minoritised ethnic communities face barriers to accessing timely and appropriate support, with greater reliance on crisis-driven pathways and more restrictive interventions. For autistic people and those with complex needs, these inequalities can be especially pronounced.
The evaluation drew on interviews with individuals and families receiving PBS, a review of PBS documentation, and a co-produced interpretation process involving practitioners, community organisations and council representatives. Although based on a small qualitative sample, several clear themes emerged.
One of the strongest findings was that PBS support was highly valued once in place. Participants and families described practitioners as patient, calm and attentive listeners. Many spoke about the importance of finally feeling heard and understood, particularly after previous experiences of services that felt rushed or dismissive. Families also highlighted the practical benefits of PBS interventions, including visual supports, clearer routines and environmental adjustments that helped reduce distress and improve day-to-day communication.
At the same time, a recurring challenge was that support often arrived too late. In several cases, families described long periods of escalating difficulty before PBS was introduced, by which point they felt exhausted and operating in survival mode. This points to an important systems issue: while PBS is intended as a preventative and proactive approach, it is too often accessed only once situations have reached crisis point.
A further theme centred on the importance of cultural context. Families consistently described practitioners as respectful and supportive, but some reflected that aspects of their cultural background and the realities of family life were not always fully recognised in support planning. Communication was also highlighted as an issue, with some information experienced as overly technical or difficult to interpret at times of high stress. These findings reinforce the need for services to ensure that support is not only person-centred, but culturally responsive and accessible.
The evaluation also highlighted wider pressures affecting families, including housing instability, challenges within education systems and cumulative family stress. These broader influences were not always fully visible within the documentation reviewed, underscoring the importance of maintaining a genuinely holistic understanding of people’s lives and circumstances.
For PSG, these insights are directly informing our ongoing co-production work. Through collaboration with autistic professionals from Autistic Radio and with individuals and families who have previously received support, we are actively reflecting on how our services are experienced in practice. This includes exploring how holistic, understandable, inclusive and culturally responsive our support feels, and how individuals can be genuine partners in shaping the services they receive.
Importantly, this work is not only about reflection but about co-designing solutions. Lived experience is helping to shape our materials, language, processes and day-to-day practice, ensuring that PSG’s support continues to evolve in ways that are meaningful, responsive and effective.
